| NPI | 1669786166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WV0400X Optometrist Vision Therapy (Licence: FL OPC4575) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV007630) |
| 152WV0400X Optometrist Vision Therapy (Licence: NY TUV007630) | |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2015-06-18 |